Doctors Day Q&A with Dr. Nate Selden

In celebration of National Doctors Day, we sat down with Dr. Nate Selden to ask what inspired him to become a physician – and what continues to inspire him in his day-to-day life as the Campagna Chair of Pediatric Neurosurgery at Doernbecher and Director of OHSU’s Neurological Surgery Residency Program.

Why did you become a physician?

Although my father and both grandfathers were doctors, I was pretty certain until almost the end of college that I did not want to become a physician. I was interested in history and political science, and spent a year of college living and studying in Italy. During my studies, however, I also developed a fascination for the brain and how it underlies everything that makes us human.

After graduating from Stanford University, I had a wonderful opportunity to study for three years at Cambridge University, as a Marshall Scholar and guest of the British government. This gave me a chance I never otherwise would have had to study the brain full time and develop a deeper understanding of its function. At Cambridge, I earned a PhD in neuroscience, and prepared for a career in basic research. But as my studies in England drew to a close, I realized my fascination with the brain was founded on a curiosity about people. I wanted to spend my career ‘hands on’ with the people I had been curious about as a scientist.

So, instead of a post-doctoral laboratory position, I returned home to begin medical school at Harvard. It was a great decision. On my second day of medical school, I met my future wife (a classmate). And I love being a doctor!

What’s something people might be surprised to know about your career?

Because I changed my career direction towards the end of college, I was missing some of the necessary prerequisites for medical school, such as the final class in the organic chemistry series. To my surprise, I convinced most of the medical schools I was interested in to waive this entry requirement, and got started on my medical studies. Halfway through the first semester, though, I found out why organic chemistry is required for pre-medical students: I failed the midterm examination for my medical school biochemistry class. After studying day and night for two weeks straight, I passed the final with a solid mark, and my medical career carried on.

Day to day, I never use any of the information I studied in biochemistry. I do use my knowledge of neuroscience, however, not just to treat brain diseases, but also to understand how young adults learn and improve. One of my most rewarding activities as an academic neurosurgeon has been to develop new systems for teaching safety and professionalism to young trainees using simulation courses, as well as new ways to objectively assess progress towards safe, independent practice. Every neurosurgeon we train well will take care of thousands of patients that I will never even see; that is high impact!

What’s the most difficult part of your job?

The most difficult part of my job is taking care of dying children, with severe brain injury or incurable cancer. It is very difficult talking to parents about these unthinkable tragedies. However, it is as important to do so compassionately and supportively as it is to do a brain or spinal cord surgery well. Both are key parts of my job.

And the most rewarding?

The most rewarding part of my job comes in two parts. One is to see a patient back in my clinic after a challenging operation with a great outcome. When I can reassure parents that the prognosis is good, I see the strain and worry lift from their shoulders. And I see that the children, especially the younger ones, are simply their resilient selves, blissfully unaware of how serious their condition was. The second part is to share that experience with the resident trainees who care for children with me. Their wonder and deep satisfaction as they experience these successes for the first time are palpable. Occasionally, we inspire one of them to pursue pediatric neurosurgery, and that is a terrific endorsement of the work we do at Doernbecher.

What advice would you give aspiring physicians?

Spend time with practicing physicians and surgeons to see what their day-to-day life is really like. Make sure you enjoy the rhythms of a normal medical routine and not just the idea of being a doctor. Medicine is a labor of love that requires diligence and resilience. If you have a passion for the work, it is its own reward.